Expanded criteria for carcinoid liver debulking: Maintaining survival and increasing the number of eligible patients

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Abstract

Background. Cytoreduction of carcinoid liver metastases typically aims for $90% debulking in patients without extrahepatic disease. Data on the impact of less-restrictive resection criteria and other clinical and tumor-specific factors on outcomes are limited. Methods. Records of carcinoid patients undergoing liver debulking from 2007 to 2011 were reviewed. Debulking threshold was 70%, extrahepatic disease did not preclude cytoreduction, and positive margins were allowed. Kaplan-Meier liver progression-free (PFS) and disease-specific (DSS) survival were calculated and compared by log-rank analysis and statistical significance of differences in distributions of factors between patient groups was determined by chi-squared analysis. Results. Fifty-two patients were identified. Complete resection of intrahepatic and extrahepatic gross disease was achieved in 12 patients. All primaries reviewed were low grade, but one third of patients had at least one intermediate-grade metastasis. Fifteen patients (29%) had liver progression; median PFS was 72 months. Five-year DSS was 90%, with all deaths from liver failure. Only age was an important prognostic factor for PFS and DSS. Five-year DSS for patients

Original languageEnglish (US)
Pages (from-to)1369-1376
Number of pages8
JournalSurgery (United States)
Volume156
Issue number6
DOIs
StatePublished - 2014

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Carcinoid Tumor
Survival
Liver
Neoplasm Metastasis
Liver Failure

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

@article{5b77b0f1982a49df9e4f83a2903ca145,
title = "Expanded criteria for carcinoid liver debulking: Maintaining survival and increasing the number of eligible patients",
abstract = "Background. Cytoreduction of carcinoid liver metastases typically aims for $90{\%} debulking in patients without extrahepatic disease. Data on the impact of less-restrictive resection criteria and other clinical and tumor-specific factors on outcomes are limited. Methods. Records of carcinoid patients undergoing liver debulking from 2007 to 2011 were reviewed. Debulking threshold was 70{\%}, extrahepatic disease did not preclude cytoreduction, and positive margins were allowed. Kaplan-Meier liver progression-free (PFS) and disease-specific (DSS) survival were calculated and compared by log-rank analysis and statistical significance of differences in distributions of factors between patient groups was determined by chi-squared analysis. Results. Fifty-two patients were identified. Complete resection of intrahepatic and extrahepatic gross disease was achieved in 12 patients. All primaries reviewed were low grade, but one third of patients had at least one intermediate-grade metastasis. Fifteen patients (29{\%}) had liver progression; median PFS was 72 months. Five-year DSS was 90{\%}, with all deaths from liver failure. Only age was an important prognostic factor for PFS and DSS. Five-year DSS for patients",
author = "Graff-Baker, {Amanda N.} and David Sauer and Pommier, {Su Ellen Johnson} and Rodney Pommier",
year = "2014",
doi = "10.1016/j.surg.2014.08.009",
language = "English (US)",
volume = "156",
pages = "1369--1376",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Expanded criteria for carcinoid liver debulking

T2 - Maintaining survival and increasing the number of eligible patients

AU - Graff-Baker, Amanda N.

AU - Sauer, David

AU - Pommier, Su Ellen Johnson

AU - Pommier, Rodney

PY - 2014

Y1 - 2014

N2 - Background. Cytoreduction of carcinoid liver metastases typically aims for $90% debulking in patients without extrahepatic disease. Data on the impact of less-restrictive resection criteria and other clinical and tumor-specific factors on outcomes are limited. Methods. Records of carcinoid patients undergoing liver debulking from 2007 to 2011 were reviewed. Debulking threshold was 70%, extrahepatic disease did not preclude cytoreduction, and positive margins were allowed. Kaplan-Meier liver progression-free (PFS) and disease-specific (DSS) survival were calculated and compared by log-rank analysis and statistical significance of differences in distributions of factors between patient groups was determined by chi-squared analysis. Results. Fifty-two patients were identified. Complete resection of intrahepatic and extrahepatic gross disease was achieved in 12 patients. All primaries reviewed were low grade, but one third of patients had at least one intermediate-grade metastasis. Fifteen patients (29%) had liver progression; median PFS was 72 months. Five-year DSS was 90%, with all deaths from liver failure. Only age was an important prognostic factor for PFS and DSS. Five-year DSS for patients

AB - Background. Cytoreduction of carcinoid liver metastases typically aims for $90% debulking in patients without extrahepatic disease. Data on the impact of less-restrictive resection criteria and other clinical and tumor-specific factors on outcomes are limited. Methods. Records of carcinoid patients undergoing liver debulking from 2007 to 2011 were reviewed. Debulking threshold was 70%, extrahepatic disease did not preclude cytoreduction, and positive margins were allowed. Kaplan-Meier liver progression-free (PFS) and disease-specific (DSS) survival were calculated and compared by log-rank analysis and statistical significance of differences in distributions of factors between patient groups was determined by chi-squared analysis. Results. Fifty-two patients were identified. Complete resection of intrahepatic and extrahepatic gross disease was achieved in 12 patients. All primaries reviewed were low grade, but one third of patients had at least one intermediate-grade metastasis. Fifteen patients (29%) had liver progression; median PFS was 72 months. Five-year DSS was 90%, with all deaths from liver failure. Only age was an important prognostic factor for PFS and DSS. Five-year DSS for patients

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U2 - 10.1016/j.surg.2014.08.009

DO - 10.1016/j.surg.2014.08.009

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JO - Surgery (United States)

JF - Surgery (United States)

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